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1、Psychological Stress and Psychosomatic Disease (心理应激与心身疾病),朱熊兆 教授 中南大学医学心理研究所 湘雅二医院医学心理中心,Conceptions(基本概念), What is psychosociological factors Diseases causes: Biological and abiological factors Abiological factors: psychosociological factors include psychological and social factors, What is psycho
2、logical factors? Cognition (认知), feeling(情感), will(意志), behavior(行为), personality(人格). Cognition is most important.,psychosociological, What is cognition? Thoughts and evaluate to environment and oneself(对环境和自身的认识、评价) including：insight, attention, memory、analyse, thought, IQ ，and so on.,psychosociol
3、ogical, What is social factors（社会因素）: marriage, family, occupation, education, policy, social change or reform, condition of life, medical condition and so on.,psychosociological,The relationship between psychological factors and social factors（心理因素与社会因素的关系）: interacting,psychosociological, What is
4、stress? Stress: psychological stress and physical stress（心理应激和躯体应激） Chronic stress and acute stress(急性应激与慢性应激),stress,1. The relationship between stress and stimulate （应激与剌激的关系）,stress,2Stress is kind of defense response for development and living of individual （应激是一切生命为了生存和发展所必需的防御反应） it is defense
5、 responses，responses may include physiological, cognitive, emotional, and behavioral changes “fightflight” (战斗与逃跑),stress,3Perceived threaten（应激是一种觉察到的威胁） emphasize the relationship between the individual and the environment,stress,definition of stress,Stress is a negative emotional experience accom
6、panied by predictable biochemical, physiological, cognitive, and behavior changes that are directed either toward altering the stressful event or accommodating to its effects （应激是个体面临或察觉到环境变化，应激源对机体有威胁或挑战时，作出的适应或应对的过程） Relationship between Lifespan and IQ ?,stress,Stressor（应激源）,Physical（物理的） ：noise
7、Chemical（化学的）: alcohol, drug (addiction) Biological（生物的）: pain, disease, fatigue Social（社会的）: social policy Psychological（心理的）: bad relationship, relatives death Culture（文化的）: living environment changes, Somatic stressor（躯体性应激源） Including physical , chemical, biological (disease) Cognition is import
8、ant（无病呻吟） symptoms evaluate serious psychological stress,stressor, Psychological stressor（心理性应激源） 个体的心理冲突或心理矛盾导致焦虑、恐惧、抑郁等各种消极情绪（stress reaction） 心理冲突(psychological conflict)：是相互对立或排斥的目的、愿望、动机或反应倾向同时出现时引起的一种心理状态。 受认知影响 分成三大类：,stressor,1 approach-approach conflict(双趋冲突) (fish, bears paw) 2. avoidance-
9、avoidance conflict (双避冲突) 3 approach-avoidance conflict （趋避冲突）,Social stressor(社会性应激源),1amative ,marriage, family（恋爱、婚姻、家庭） 2. from the Workplace (occupational stress)（职业场所）: Work overload is a chief factor producing high levels of occupational stress. Ex, work too long and too hard. Work pressure l
10、eads to stress. Role conflict and role ambiguity are also associated with stress. The inability to develop satisfying social relationships at work has been tied to job stress. Unemployment.,stressor,3. from social common suffer（共同问题及个人遭遇） (war, tsunami ) 4.from culture（文化性） :are experiencing rapid s
11、ocial and technical change, socioeconomic positions in society.,Stress reaction（应激反应）,Psychological reaction（心理反应） emotional and behavior Somatic or physical（躯体反应）,Psychological reaction,1.Emotional reaction（情绪反应） anxiety fear depression anger,2. Behavioral reaction（行为反应） high arouse（警觉水平增高） escape
12、and avoidance （逃避与回避） regression and dependence（退化与依赖） hostility and attack（敌对与攻击） Abuse（物质难用）,Somatic reaction（躯体反应）,psychosomatic reactions（心身反应） psychosomatic disorders（心身障碍） Psychosomatic diseases（心身疾病）,Vulnerability of stress,Psychological: cognition (early experence, attachment style, self-est
13、eem) Gene ：serotonin transporter （5-HTT）polymorphism,Characteristic features of psychosomatic diseases,1. psychosociological factors act as a role(心理社会因素起一定的作用) 致病作用：原发性高血压、糖尿病等 诱发作用：哮喘（如，玫瑰花粉哮喘）、冠心病心绞痛等 影响转归： 糖尿病、冠心病 心肌梗塞等,2.Features of psychological factor(心理因素的特点)： 慢性、长期的, 如，工作中的人际关系；家庭、婚姻等。 3.or
14、ganic changes (具有器质性的改变或病理生理改变) 生化检查异常或明显体征（冠心病、糖尿病等）; 病理生理过程（偏头痛） 4. Personality-related（与某种特殊性格类型相联系）： 不同的性格类型易患不同的心身疾病,5. Family history(相同或类似的家庭史) 6. Co-corbidity (同一患者可有几种疾病同时存在或交替发生) 7.Relapse (疾病经常有缓解和复发的倾向) 8. age-related(年龄特点),coping styles（应对方式）,coping strategies or coping styles (减轻应激对自身影
15、响的各种策略，对抗应激的手段) defense mechanism（防御机制）,Denial(否认) Rationalization (合理化) Fantasy (幻想) Displacement (转移) Reaction (反向) Sublimation (升华) Humor (幽默),The stage of stress reaction （应激反应的分期）,1Alarm reaction(警戒反应) 为“fight-flight”反应作准备。应激消失，反应消失。 Stress hormone，Bp ，P，R，BSfight or flight (Psychosomatic react
16、ion),2Resistance(抵抗期) 应激持续存在,或过强，第一阶段不能恢复，进入第二阶段。 Psychosomatic disorder,3Exhaustion(衰竭期)：生理、心理能量被耗竭 Psychosomatic diseases or death,医患关系与医患沟通,医患沟通与医患关系,沟通: 传出与接受（双向），分享信息、思想和情感的过程，是互动的过程 医患沟通：特殊的沟通，医护人员与患者（包括患者家属）之间，有效传递医疗信息，并准确理解患者表达的信息， 沟通是一种技能，可通过训练而提高,医患关系：是一种特殊的人际关系，特殊的人际关系。 医务人员与病人在疾病的诊断、治疗过程中所形成的相互关系 与一般人际关系的区别：目的性、时限性,医患沟通的目标,终极目标：有利于明确诊断和制订治疗方案，提高治疗的依从性 近期目标（1）建立良好的医患关系；（2）收集信息；（3）理解患者的想法并与患者就重要问题进行讨论；（4）与患者在对疾病的理解和治疗方案上取得一致的看法，并使他们能以平等的合作者身份
